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18.
Upper airway resistance syndrome:
A group of children with:
Symptoms of (OSAS) excessive daytime somnolence but
Without polygraphic apnea and hypopneas.
Rather repeated central nervous system arousals, during
sleep
However, these children were found to have increased
respiratory efforts during sleep.
Using esophageal manometry as a measure of respiratory
effort, it was noted that such arousals were preceded
by increased respiratory effort.

19.
The typical presentation of UARS
patients:
Daytime somnolence,
Not obese,
May or may not snore,
But typically has a narrowed upper
airway anatomy.
particularlyhypotension,Of interest,
postural hypotension, seems to be a
common finding in such patients, in
contrast to OSAS where hypertension is
the usual finding.

31.
Anesthesia Considerations:
Children with OSA with a cold should be
postponed for 4 weeks.
Children with signs and symptoms
suggestive of severe OSA with cardiac
involvement need to be assessed by a
cardiologist prior to surgery
The improvement is not immediate, but
children are dramatically improved in
the weeks after surgery.

32.
Premedication:
Sedative premedication should be
avoided for children with OSA.
Parents to accompany the child to the
anaesthetic room to reduce the child‟s
anxiety.

33.
Induction:
May be gaseous or intravenous, depending
on the child and the preference of the
anesthetist.
Immediately after induction” with the loss
of pharyngeal tone “ airway almost
obstruct & may be relieved by jaw thrust
and the application of CPAP.
As soon as the child is deep enough an oral
airway should be inserted and effectively
relieves the obstruction.

34.
Induction (Continue):
Children with severe micrognathia (expected will
not be easy to intubate) a cautious gas
induction is sensible in this situation.
Intubation and electively ventilation of children
with severe OSA, usually using a short acting
non-depolarising NMBDs.
Intubation under deep anesthesia without muscle
relaxant is unwise in this situation.
Suxamethonium should be used if non depolarising
agents are not available.

35.
Maintenance& Recovery:
Children with severe OSA have been
estimated to require 50% less opioid than
normal children due to increased opioid
sensitivity.
Analgesia should be carefully titrated to effect,
Simple analgesics should be used.
Awake Extubation at the end of surgery.
Opioid analgesia should be kept to a minimum
in the postoperative period.
Insertion of a nasopharyngeal prong airway
(NP airway) for these children at the end of
surgery

36.
Postoperative:
Airway obstruction is not relieved immediately after
surgery in children undergoing adenotonsillectomy for
severe OSA. This is mainly due to edema and swelling
at the operation site, which improves in the first 24-
48 hours after surgery.
The child is nursed on the high dependency area (HAD)
with the NP airway in position for the first night at
least – it is very important to regularly do suction the
airway with soft suction catheter.
Careful overnight observation, using saturation
monitoring as part of routine monitoring on the ward /
HAD , but do not administer oxygen to those with
severe OSA unless required.